Cardiovascular Disease – Managing the Impact on Workplaces

bh in Brief

Globally, Amgen is a leading human therapeutics company. Since 1991, Amgen Canada has been an important contributor to Canada’s biotechnology sector, applying science and innovation to fight illness and dramatically improve people’s lives, and contributing to philanthropic efforts in the community.  Amgen Canada supports education initiatives that help Canadians through the cancer journey or navigate their treatment landscape in bone health, kidney disease or autoimmune disorders. The company is committed to raising the value of science literacy, attracting bright young minds to science by helping educators teach more effectively, and improving access to science resources for teachers, students and the community. Amgen Canada is located in Mississauga, Ontario, with a research facility in Burnaby, British Columbia.


“to give back to the communities where our staff members live

and work.” 


Amgen Canada Inc. n.d.

Anti-PCSK9 Drugs and Private Drug Plans.

Heart and Stroke Foundation 2015. Statistics.

Pandey, A. S. 2015, November 19.

We are living in the Age of the “Cure”:

A message of Hope & Empowerment.

Presentation. Pathways Symposium, Kitchener, Ontario. 


Cardiovascular Disease (CVD) is no stranger in the workplace. It is there with employees whose health history includes a heart attack or stroke or who say they have hardening of the arteries, high blood pressure or high cholesterol. It is lurking in the background for those with other risk factors like smoking, diabetes or obesity. It is a leading cause of death and hospitalization in Canada and the biggest driver of prescription drug use in the country (Heart and Stroke Foundation). 

Preventing CVD

Even so, over the past 60 years, death rates have declined by more than 75%, thanks to advances in surgery, drug therapies and prevention. In fact, we now know that modifiable risk factors account for 90% of the risk of heart disease (Pandey). Still, understanding CVD, in itself, will not lead to a reduction in disease if action is not taken to reduce known risk factors. Among those factors, high cholesterol, specifically low density lipoprotein cholesterol (LDL-C), is a major risk. Lowering cholesterol is not a simple process. In recent years, pharmaceuticals known as “statins” have been widely used and have effectively reduced levels of cholesterol for many patients. Now, a new class of biologic drugs is coming on stream and plan managers may be asking why new drugs are needed, and who should take them. 

Answering the Questions

Before getting to the why and who of the new drugs, some basic facts may be in order. Cholesterol is a broad term for fatty molecules that circulate within the blood stream. Two types of cholesterol affect the body: high density (HDL-C) which has positive effects, and the low density (LDL-C) identified above which contributes to CVD. Excess LDL-C can build up in arteries, forming plaque, restricting the flow of blood (atherosclerosis). This build-up of plaque makes it harder for the heart to circulate blood and can also result in the formation of blood clots. When a clot blocks an artery to the brain, a stroke results; when it blocks an artery to the heart, it leads to a heart attack. 

Although statins work well for many, a sub-set of patients cannot reach the Canadian LDL-C target, even with maximally tolerated statin therapy. This sub-set remains at high risk of having a CVD event and tends to include patients with a serious form of CVD who are likely to have already experienced a heart attack or stroke. More aggressive treatment is also required for another group with an inherited genetic disorder known as Familial Hypercholesterolemia (FH) which can be diagnosed in childhood. If untreated, people with FH have up to twenty times the risk of developing early aggressive heart disease. It is for these two relatively small sub-sets of patients that Health Canada has approved a new biologic, known as an anti-PCSK9 drug because it inhibits the action of PCSK9, a protein that prevents the liver from eliminating LDL-C

Implications for Benefit Plans

In deciding whether to cover the new biologics, there are a number of factors to consider. In this case, the cost of coverage is constrained by the fact that the drugs are only approved for the two sub-sets of patients described above. Such limited approval means that relatively few employees are likely to require the coverage. Also, coverage has benefits for both individual employees and the workplace. The new therapies are recommended only for patients at high risk for future illness or death. Should serious illness or death occur, the entire workplace team is also affected. Social/emotional costs may be high and the workplace is at risk for reduced productivity and its subsequent impact on the bottom line. bh


Categories: Disease Management